M MOHD SLIM 1, H LALA , N BARNES , R MARTYNOGA
1Department of Critical Care, Waikato District Health Board, Hamilton, New Zealand
BACKGROUND: Māori in New Zealand (NZ) are disproportionately affected by chronic kidney disease (CKD), and experience lower life expectancy on community dialysis compared to non-Māori. We previously identified higher renal replacement therapy (RRT) requirement for Māori in our intensive care unit (ICU), the tertiary referral centre for NZ’s Te Manawa Taki region.
AIM: Describe mortality outcomes by ethnicity in the RRT-requiring population in our ICU.
METHODS: Retrospective audit of the Australia and NZ Intensive Care Society database for adult admissions to our general ICU from Te Manawa Taki between 2014-2018. Patients were stratified by non-RRT requirement (non-RRT), RRT-requiring acute kidney injury (AKI-RRT), and RRT-requiring end-stage renal disease (ESRD).
RESULTS: Relative to the Te Manawa Taki population, Māori were overrepresented across all strata, especially ESRD (61.8%), followed by AKIRRT (35.0%), and non-RRT (32.4%) (p<0.001). There was no ethnic inequity in mortality outcomes within any stratum. Crude in-ICU mortality was similar by ethnicity amongst AKI-RRT (30.8% amongst Māori, vs 31.5%, p=1.000), and ESRD (16.4% amongst Māori, vs 20.6%, p=0.826). This trend remained at 1 year. Adjusted for clinically selected variables, neither AKI-RRT nor ESRD mortality was predicted by Māori ethnicity, both in-ICU and at 1-year. Irrespective of ethnicity, AKIRRT patients had highest in-ICU mortality (31.2%) (p<0.001), whilst ESRD had highest 1-year mortality (46.1%) (p<0.001).
CONCLUSION: Increased RRT requirement amongst Māori in our ICU is due to higher representation amongst ESRD. There was no excess mortality by ethnicity across all strata. AKI-RRT had higher in-ICU mortality than ESRD, but this reversed at 1-year.
The presenter is an advanced trainee in adult intensive care (College of Intensive Care Medicine) and adult internal medicine (Royal Australasian College of Physicians) based in New Zealand.